Ninja Shark Air Filter - Request form

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This form is to be used only to request Ninja Shark Air Filter Full Face Snorkel Masks for Frontline Healthcare workers in Australia treating Coronavirus. We prioritise those that work in the ER / ICU.

Even if you are not in a hospital, you should still submit a request, so that we can get the necessary supplies to you as soon as we will be able to. We will reach to you once we are able.

Email *

Your Name *

Your phone number *

Name of hospital/institution you are requesting for *

Full address of the hospital / institution *

Your Job Title / Affiliation with the Hospital *

What equipment is most needed at your hospital? Please include amounts wherever possible and be as specific as possible *

If you are not the hospital supply administrator, what is the contact information of your hospital supply administrator? *

Who should be the point-person to coordinate the pickup/shipping of supplies to? *

Approximately, how many COVID-19 patients is your hospital treating right now? *

How low in supplies are you? *

We currently have supplies, but expect to run out soon

We have very low supplies and are rationing

We have none and are in dire need

Other:

Anything else we need to know? Questions? Comments?

It would be very helpful if you can share our campaign with the doctors, nurses & healthcare workers at your hospital and ask them to send out our link to their communities: They can also reach us at support@ninjashark.com.au. The more attention we get, the better able we will be in securing more shipments of supplies.

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